The last time you called your doctor’s office, how long did you have to wait for a response? How long do you typically have to wait for an appointment or to wait for a call to fill a prescription? When you arrive at the office, how much time do you spend in the waiting room and how much time does the doctor spend with you?

Did you get answers to all your questions? How many seconds do you have at the beginning of your appointment to explain your symptoms before you are interrupted? Do nurses and doctors seem to be more interested in their computers or their charts than they are in you?

If your experiences are like most people, your answers to these questions are not very flattering to the medical profession and the health care system in general. Most doctors really don’t want their practices to be like this, but they don’t have much of a choice. They must have a high volume of patients to be able to make ends meet financially. The high volume makes the clinic a very busy place and most patients don’t feel like they get much attention.

In 1996 in Seattle, a doctor named Howard Moran thought there might be a better way to do this. He pioneered the concept of having a lower volume practice with highly attentive medical care provided as a service to patients for a retainer fee, much like many attorneys or accountants. This fee may be in addition to or in lieu of regular office fees that are billed to insurance companies. This concept allows the practice to remain financially solvent while providing better and more responsive medical service to its low patient volume (generally keeping the patient countdown to about a tenth of the number in a typical traditional primary care practice).

Unfortunately, health insurance companies currently don’t pay for this type of service, which means patients have to pay out of pocket, but if the service is good, it can be worth it. Patients joining these practices are encouraged to maintain their regular insurance that they will need for visits to other specialists, laboratory tests, radiological tests, and/or hospital services if necessary.

Many concierge practices offer same day or next day appointments, no long waits for appointments or prescription refills, direct access to your personal doctor day or night, home visits if needed, ongoing care if hospitalized , complete physical exams, audiometry screening tests, cardiovascular and cancer risk. screening, more attention to preventive care, unhurried appointments, all questions answered, family meetings if needed, coordination of care with specialists, provision of personal health records on CDs or flash drives, etc, etc.

Depending on the type and number of services being provided, the retainer flat fee can vary widely from area to area, anywhere from $100 to $20,000 per year, most likely averaging around $1500-3000 per year. There were only a few hundred of these doctors a few years ago, but now there are more than 5,000 of them across the country. Many, but not all, of them are listed on the main website of the American Academy of Private Physicians: http://www.aapp.org/. Patients can find a concierge doctor in their area on this site.

There has been some controversy surrounding some of these practices because some authorities believe that the growth of concierge medicine will lead to a two-tier medical system in this country: one for the rich and one for the not-so-rich. Additionally, with the current shortage of primary care physicians (PCPs), with an increasing number of concierge practices, the number of PCPs available to traditional practices will be even fewer, and access to care for patients served by those practices practices will be affected. On the other hand, more medical students may be interested in primary care if opportunities in concierge medicine are available when they complete their residencies.

Some of these practices have been criticized by insurance companies who say concierge physicians basically provide an insurance plan for their patients without having an insurance license to do so. Therefore, practices must be legally and financially structured in such a way as to avoid this criticism.

Overall, the concept of concierge medicine provides a good alternative to the currently unsatisfactory traditional model of medical practice. The fee may seem high to some, but in most cases, it’s probably not much higher than the cost of your local cable or phone bill, or about the same as what a family would spend eating at a restaurant once a week. .